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Herpetic Whitlow Treatment & Management

  • Author: Michael S Omori, MD; Chief Editor: Steven C Dronen, MD, FAAEM  more...
 
Updated: Oct 26, 2015
 

Emergency Department Care

Herpetic whitlow is a self-limited disease. Treatment most often is directed toward symptomatic relief.

Acyclovir may be beneficial. Studies of clinical efficacy are limited and treatment suggestions are extrapolated from data regarding response of other HSV infections. In primary infections, topical acyclovir 5% has been demonstrated to shorten the duration of symptoms and viral shedding. Oral acyclovir may prevent recurrence. Doses of 800 mg twice daily initiated during the prodrome may abort the recurrence. Alternative dosing regimens may also be effective.[5]

Famciclovir or valacyclovir may shorten the clinical manifestations of acute occurrence.[6]

Topical penciclovir may be beneficial.

Use antibiotic treatment only in cases complicated by bacterial superinfection.

Tense vesicles may be unroofed to help ameliorate symptoms, and wedge resection of the fingernail may be used for the same purpose in cases involving the subungual space.

Deep surgical incision is contraindicated, since this may lead to delayed resolution, bacterial superinfection or systemic spread, and complications such as herpes encephalitis.

 
 
Contributor Information and Disclosures
Author

Michael S Omori, MD Attending Staff, Emergency Medicine Residency, St Vincent Mercy Medical Center; Acting Director, Pediatric Emergency Center, Mercy Children's Hospital; Clinical Assistant Professor, Department of Surgery, University of Toledo Medical Center, The University of Toledo College of Medicine

Michael S Omori, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Eric L Weiss, MD, DTM&H Medical Director, Office of Service Continuity and Disaster Planning, Fellowship Director, Stanford University Medical Center Disaster Medicine Fellowship, Chairman, SUMC and LPCH Bioterrorism and Emergency Preparedness Task Force, Clinical Associate Professor, Department of Surgery (Emergency Medicine), Stanford University Medical Center

Eric L Weiss, MD, DTM&H is a member of the following medical societies: American College of Emergency Physicians, American College of Occupational and Environmental Medicine, American Medical Association, American Society of Tropical Medicine and Hygiene, Physicians for Social Responsibility, Southeastern Surgical Congress, Southern Oncology Association of Practices, Southern Clinical Neurological Society, Wilderness Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Steven C Dronen, MD, FAAEM Chair, Department of Emergency Medicine, LeConte Medical Center

Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Robin R Hemphill, MD, MPH Associate Professor, Director, Quality and Safety, Department of Emergency Medicine, Emory University School of Medicine

Robin R Hemphill, MD, MPH is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References
  1. Wu IB, Schwartz RA. Herpetic whitlow. Cutis. 2007 Mar. 79(3):193-6. [Medline].

  2. Klotz RW. Herpetic whitlow: an occupational hazard. AANA J. 1990 Feb. 58(1):8-13. [Medline].

  3. Robayna MG, Herranz P, Rubio FA, Pena P, Pena JM, Gonzalez J, et al. Destructive herpetic whitlow in AIDS: report of three cases. Br J Dermatol. Nov 1997. 137(5):812-5. [Medline].

  4. El Hachem M, Bernardi S, Giraldi L, Diociaiuti A, Palma P, Castelli-Gattinara G. Herpetic whitlow as a harbinger of pediatric HIV-1 infection. Pediatr Dermatol. 2005 Mar-Apr. 22(2):119-21. [Medline].

  5. Nikkels AF, Pierard GE. Treatment of mucocutaneous presentations of herpes simplex virus infections. Am J Clin Dermatol. 2002. 3(7):475-87. [Medline].

  6. Cunha BA, ed. Antibiotic Essentials. 7th ed. Sudbury, Mass: Physician's Press; 2008. 109.

  7. Weisman E, Troncale JA. Herpetic whitlow: a case report. J Fam Pract. 1991 Nov. 33(5):516, 520. [Medline].

  8. Patel R, Kumar H, More B, Patricolo M. Paediatric recurrent herpetic whitlow. BMJ Case Rep. 2013 Jul 31. 2013:[Medline].

  9. Hoff NP, Gerber PA. Herpetic whitlow. CMAJ. 2012 Nov 20. 184 (17):E924. [Medline].

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